can you dive after having chemotherapy?

[Jorbar1551]

I had a customer come in who had chemotherapy. she wanted to know if she could be certafied. i told her that its up to personal doctor, but that if she was medically okay, we certafy anyone that is ready.

Does anyone dive here that had chemo or radiation treatment for cancer?

 

[diverdown247]

I'm still young in the instructor profession, but up to now, I've yet to hear of anyone that has crossed this issue/bridge. I would assume that a physician's physical is necessary and cleared on a case-by-case basis.

If/when you get an answer about your particular person/question, please post the results (no names please). Some of the instructors may be interested in the results. I know that if there was just 1 case that was cleared and that person had no complications post-class, if someone asked me if it were even possible I'd say that there is hope since it has happened in the past, but a doctor's physical is necessary.

 

[TSandM]

If the chemotherapy/radiation is finished, and the disease is controlled or cured, the only reason not to dive would be if the patient had significant cardiac or pulmonary toxicity as a result of the treatment. This can occur with certain chemo agents.

If the chemo/XRT is in progress, I would think diving would be inadvisable, unless we are talking about "chemotherapy" as hormonal manipulation. Chemo agents can be pretty toxic, can significantly affect the immune system, and often make people feel generally pretty awful.

If the underlying disease process is not controlled or cured, the risks of diving depend on what the process was and where it was. Someone, for example, with brain metastases from lung cancer would, in my opinion, be at very high risk with diving, because of the possibility of seizures.

It's a case by case call. But a history of cancer, chemo and/or XRT in the past (more than six months ago) and no active disease shouldn't, at least in my opinion, argue against diving.

 

[RICHinNC]

This is one of those times it is good to use your DAN membership, get on their site, and ask someone in the know.

 

[MXGratefulDiver]

I have a friend who celebrated cancer survival by learning how to dive. That was four years ago, and she's still an active diver today. Her biggest hurdle was that the chemo treatments sapped her strength, and it was a lot of work lugging all that heavy gear around ...

... Bob (Grateful Diver)

 

[rjack321]

DAN told me that if you aren't physically exhausted,
and the cancer and/or associated treatments are not types which are contraindicated (i.e. lung resection),
feel free to dive.

Chemo itself, while toxic, generally isn't stuff which has any greater or lessor effects at depth.

 

[rexb]

I am having trouble figuring out how to start a new thread, so I will add on to this one, with similar questions, and would appreciate referral to sources for additional reading, especially if you are a physician, or know physicians who ae diving enthusiasts.

I am a 53 yr old physician, novice diver (open water certification in May 2006), and I have my own questions about diving following treatment for cancer. The patient is myself. My own career is in newborn intensive care, so I am not qualified to formulate a detailed answer for myself, as I do not take care of adult patients.

I agree with those who say that chemotherapy and/or radiation therapy per se are not reasons to consider any adult contraindicated to dive. As already noted above, it might be wise to have a follow-up cardiac evaluation post-treatment (if you received doxorubicin, also known as Adriamycin or other related, potentially cardiotoxic drugs); similarly, a pulmonary evaluation post-treatment if you received bleomycin (can cause pulmonary toxicity) or if you had any unusual pulmonary infections or pneumonia during your treatment (for example, fungal pnumonia or Pneumocystic carinii pneumonia). Likewise, if your cancer treatment involved any significant cardiac, thoracic or pulmonary surgery or adverse effects or cancer in the chest itself. These caveats seem fairly self-explanatory to me.

My question has to do with: "how soon... after seemingly successful cancer treatment is it okay to dive?" - - assuming there are no obvious cardiac or pulmonary issues?"

I was diagnosed with grade II/ stage II non-Hodgkins lymphoma (follicular mixed [large] cell, for those who would be interested in such details); it was limited to my neck only, but it was aggressive and fast-growing in the six weeks prior to starting treatment. Despite this, I really had no significant symptoms other than some mild airway compression, essentially only evident as modest worsening of sleep-associated breathing.

Now, the good news: after only two cycles (November 15 and November 29), I have had a dramatic response to therapy, and by physical examination (of the nodes in my neck), I am already in complete remission. The mass(es) of lymphoma in my neck have completely melted away, or are smaller than BB-size now (I cannot feel them at all). My lymphoma cannot be considered _eradicated_ entirely right now, and I will undergo a minimum of two more cycles of chemotherapy (December 14 and December 28) and a repeat scan... which will show (I hope) what my fingers can already feel: it's gone, for all practical purposes (even though that might _not_ include eradication at the microscopic level).

I am already planning the "victory" celebration, and I would like to go to Key Largo just three weeks after my fourth (final?) cycle of chemotherapy, January 18-21.

These are the issues that are... hopefully... generically useful to any post-treatment cancer patient - - and I am hoping that some diving-knowledgeable physician can point me to info, worth sharing with my oncologist, to ascertain whether I am _ready_ to dive again.

1. First, and possibly the most "eye-opening"... I still have my _port_ (also known as an Infusa-port); this is an entirely under-the-skin, intravascular device used to simplify intravenous access. I will probably keep it, "just in case", for ... maybe six more months? - - it really requires no medical managment, other than flushing it once a month by a qualified nurse or physician, with heparin (an anticoagulant, injected by needle through the skin over the port, to prevent clotting). It would be difficult, silly and wrong to try to conceal it from any diving guide; it is somewhat visible, directly under my right clavicle. I believe that it is not a contraindication to diving, but it would be useful to have info or even opinions from someone with specific experience with this question.

2. There will be the reasonable questions about whether I should avoid diving on the grounds of whether my immune system is "back to (sufficiently) normal" to avoid ordinary infectious risks, associated with travel or diving. Normal blood count is an obvious yardstick, but I would also be curious if any diving-knowledgeable physician can comment on whether immunglobulin (blood) levels ought to be checked (in my case, they were not checked before or during treatment, so I don't know what degree of reduction would be evident without previous baseline levels).

3. Finally, and this would go beyond "just" cancer patients. I now have mild anemia, and it will likely get slightly worse before it gets better. I may start treatment for anemia later this month or in January. How low is too low, to dive? My hemoglobin right now is still "average" for an adult (pre-menopausal) woman, after all... and it is probably higher than many women, one month after normal childbirth, for example. Are there guidelines for women who wish to dive after delivery, or those with various other kinds of anemia (thalassemia or sickle cell anemia, for example). Many older divers will have mild anemia after various kinds of medical treatment. It seems likely that some guidelines exist.

I will try to research these question myself, and post back here as I hear feedback from othr medically-knowledgeable divers and/or diving-knowledgeable physicians.

In the final analysis, I will ask my own doctor (oncologist) to "sign off" on my diving again next year, but I suspect that he will be operating from a largely "best-guess" perspective, and he will surely appreciate any relevant reference materials.

Thanks in advance for any replies.

Best wishes,

Rex Bickers, M.D.
Floyds Knobs, Indiana

 

[Midnight Star]

I would let my system come back upto speed, as best it could, before taking on the additional stress of diving, just to make sure "complications" didn't arise from the chemo/radiation process, and get compounded by a personal activity.

-----

Mike.

 

[TSandM]

Rex, I'm not sure you're going to get any useful answers, because the intersection of the set of people undergoing chemo for lymphoma and the set of divers is so small that there's undoubtedly no useful literature on the subject.

As far as mild anemia goes, I would think it would be no problem. You're going to be operating under elevated pp02s at depth, with high hemoglobin saturations, so if anything, you'd be better off underwater than on land.

I really can't think of any way that diving is a signficant immune challenge, unless you swallow a great deal of contaminated water, so measuring immunoglobulin levels would be, I think, unnecessary.

The Groshong or whatever port you have is fluid-filled and should not be an issue with diving, at least as far as I can see.

But you are probably is just as good a position as I am to make these judgment calls. There's no literature . . . You just have to take the knowledge you have and extrapolate it as best you can.

 

[fisherdvm]

My concern would be if a "normal" person have difficulty eradicating atypical mycobacterium, would a post chemo pt handle them as well? Every marine environment poses risk of abrasions and scrapes from dive boats, ladders, corals, wrecks, and sand. I don't know if chemo can affect your total repertoire of immune cells to do the job.

This is just my gut feeling... You certainly don't want to complicate future chemo cycles with even uncomplicated skin infections.